Examples:
1. the vehicle has a Jaguar rear-end
2. the Pez dispenser was previously owned by Joan Crawford

Loans/Claims Against the Property

There are no loans or other claims against the Property

There are loans or claims against the Property

Complete this sentence: "The property is encumbered by __________________."

Examples:
1. a registered lien for $5000 (Five Thousand Dollars) in the name of Mary Poppins
2. a loan in the amount of $800 (Eight Hundred Dollars) owed to Captain von Trapp

Assignment - Present/Future Income Details

Enter the following information for the person who has the responsibility to provide you with
the income:

Name:

Address:

City/Town:

Complete this sentence: "I am transferring the following to the Assignee: ______________."

Examples:
1. ten thousand dollars ($10,000) from the annuity bequeathed to me by the last will of Ted Turner
2. royalty payments from my book titled "Bewitched" for 6 months commencing March 3, 2014

Assignment - Intellectual Property Details

Complete this sentence: "I am transferring the following to the Assignee: _______________."

Examples:
1. my patent interest in novelty sunglasses Patent No.: US D123,456 dated March 3, 2014
2. my copyright interest in the slogan "Eat Right, Look Great" which I have
used in business since March 3, 2014

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